DiversityNursing Blog

Women of color in the United States suffer unacceptably poor maternal health outcomes, including high rates of death related to pregnancy or childbirth.

The Pregnancy Mortality Surveillance System started in 1987 and since then, the number of reported pregnancy-related deaths in the United States increased from 7.2 deaths per 100,000 live births to 17.2 deaths per 100,000 live births in 2015.

Considerable racial/ethnic disparities in pregnancy-related mortality exist. During 2011–2015, the pregnancy-related mortality ratios were—

• 42.8 deaths per 100,000 live births for black non-Hispanic women.
• 32.5 deaths per 100,000 live births for American Indian/Alaskan Native non-Hispanic women.
• 14.2 deaths per 100,000 live births for Asian/Pacific Islander non-Hispanic women.
• 13.0 deaths per 100,000 live births for white non-Hispanic women.
• 11.4 deaths per 100,000 live births for Hispanic women.

Variability in the risk of death by race/ethnicity indicates that more can be done to understand and reduce pregnancy-related deaths.

According to a report from the Centers for Disease Control and Prevention, African American mothers die at a rate that's 3.3 times greater than whites, and Native American or Alaskan Native women die at a rate 2.5 times greater than whites.

Pregnancy-related mortality rates are also high among certain subgroups of Hispanic women. A Science Direct article says, pregnancy-induced hypertension was the leading cause of pregnancy-related death for Hispanic women.

The CDC report also shows roughly 3 in 5 pregnancy-related deaths are preventable. But, the health care system fails to listen to diverse population's health concerns and so the maternal mortality rate keeps rising.

According to the Healthy People Final Review, Approximately 25% of all U.S. women do not receive the recommended number of prenatal visits.  This number rises to 32% among African Americans and to 41% among American Indian or Alaska Native women.

An article from the Center for American Progress believes there is little research on what social factors contribute to poor delivery and birth outcomes for American Indian and Alaska Native women because of the small population size and racial misclassifications. But they do know these women face many barriers when it comes to getting healthcare.

The National Partnership for Women & Families explains African American women experience more maternal health complications. 

• African American women are three times more likely to have fibroids than white women. Fibroids are benign tumors that grow in the uterus and can cause postpartum hemorrhaging. Also the fibroids occur at younger ages and grow more quickly for African American women.
• African American women display signs of preeclampsia earlier in pregnancy than white women. Preeclampsia involves high blood pressure during pregnancy and can lead to severe complications including death if not properly treated.
• African American women experience physical “weathering,” meaning their bodies age faster than white women’s due to exposure to chronic stress linked to socioeconomic disadvantage and discrimination over the life course, this makes pregnancy riskier at an earlier age.

The CDC report also shows that more than a third of pregnancy-related deaths were due to cardiovascular conditions. Cardiovascular disease is more common among black women and can occur at earlier ages than in white women.

It is very clear that health disparities have a lot to do with racism. Until it is addressed and programs are put in place to combat racism in healthcare, mortality rates will continue to rise.

We found this inspiring Pilot Program we think will be of interest to you. Healthcare provider, AdventHealth, rolled out an unusual program last year that hopes to “revolutionize” the way patient care is delivered around the country.

The goal of the pilot program, started in 2018, was to free up Nurses to provide more patient-centered care without the constant interruption of writing down the care as it was given. Nurses were paired with a Care Team Assistant (CTA) to document patients’ medical care at the time it was provided. This was done under the Nurse’s supervision and they worked as a team.

“This pilot is helping me be the type of Nurse that I dreamed of,” said Christine Reyes, a Registered Nurse at AdventHealth Altamonte Springs. “I became a Nurse because I wanted to show compassion to people who need it most, and this pilot is allowing me to do that even more.”

Results of the pilot program

·         Staff responsiveness (a measurement of the patient experience) improved by 12%.

·         Lab turnaround time improved by 13%.

·         73% of nurses said they feel they are able to spend more time with patients when assisted by a CTA.

Eric Stevens, CEO of acute care services for AdventHealth in metro Orlando said "AdventHealth is committed to finding innovative solutions to health care problems. We created this model to improve the way we work to make it easy for both our patients and staff. Our Nursing staff is key to providing compassionate, whole-person care. A hospital stay can be an unnerving experience. This program helps our Nurses spend quality time with our patients and their families to focus on supporting them while they heal."

AdventHealth is building on the success of the pilot and expanding it to other units.

What do you think of this program? Is it a good idea to implement at other hospitals? Share your ideas here.

Nurses are selfless, always giving as much of themselves as they can for their patients. Thanks to one extremely selfless Nurse, 8-year-old Brayden Auten of WI is alive and well and starting a new school year. 

One day last April, Brayden, a busy and active child, came home from school very sick. The following evening, he was at Children's Hospital in Milwaukee where doctors discovered an aggressive unknown virus attacking his liver.

According to a Wisconsin News article, within a week, young Brayden was fighting for his life. Ruth Auten, Brayden's mom said "Started talking liver transplant, and we just bawled our eyes out. We didn't think it was going to get that far."

The family posted Brayden's story online and the response was so huge, an operator was added to the unit to handle the volume of phone calls. Thankfully, Cami Loritz, an ICU Nurse in Milwaukee, answered their prayers. She was a perfect match and volunteered to be a living donor.

Brayden’s dad, James Auten said "What she did was completely selfless and she saved his life, plain and simple." Ruth said "We can't thank her enough. She's a true miracle. We consider her one of us, one of our family."

While Brayden was recovering in Milwaukee, the community back home in Wrightstown, WI came together for the family. "They set up fundraisers and everything for tournaments and just, it was really amazing to see the community support and the wrestling team came while we were gone and did our lawn and landscaping and came and saw him. It's been pretty amazing," said Brayden's dad. 

The Auten's are so thankful and grateful for the gift of life Cami gave to Brayden. To commemorate what Cami did for Brayden and his family, they organized a family photo shoot for them. You can see their bond in these photos. Cami, you are truly an amazing person!

SANE stands for Sexual Assault Nurse Examiner and it is a qualification for forensic Nurses to conduct sexual assault evidentiary exams for rape victims. SANE Nurses are trained in the medical, psychological, and forensic examination of a sexual assault victim.

SANE Nurses are extremely important in making sure sexual assault survivors feel safe as they are treated in the emergency room.

These Nurses act as an advocate for patients by staying with them for hours as they gain trust, asking the difficult questions, conducting physical exams to check for evidence and injury, providing emergency contraceptives, and maintaining evidence for law enforcement.

In addition to the collection of forensic evidence, they also provide access to crisis intervention counseling, STI testing, and drug testing. A SANE will also supply medical referrals for additional medical care or possible follow ups to document how they are healing.

To become a SANE, you must first be a Registered Nurse (or Advanced Practice), preferably with 2+ years experience in areas of practice that require advanced physical assessment skills. The SANE training should meet the IAFN SANE Education Guidelines and will consist of both classroom and clinical components.

1)       SANE-A -- for Adult and Adolescent Examiners

2)       SANE-P -- for Pediatric victims

Resources

National Protocol for Sexual Assault Medical Forensic Examinations of Adults and Adolescents 

Approved SANE Courses

Sexual Assault Nurse Examiner Education Guidelines, Adult and Pediatric

National Training Standards for Sexual Assault Medical Forensic Examiners

Nurse's innovative ideas are coming to life thanks to pop-up labs through a company called MakerHealth. MakerNurse, powered by MakerHealth, with support from the Robert Wood Johnson Foundation, was launched in September 2013 with the goal of examining Nurse innovation in U.S. hospitals and identifying tools and resources that could help more Nurses bring their ideas to fruition and lead improvements in patient care. Their solutions, informed by this research, are being adopted by institutions across the country. 

Nurses are natural problem solvers and spot any barriers in providing the best health care. So it would be in everyone's best interest to support Nurse's ideas and provide them the tools to create.

MakerHealth Space is situated inside a hospital. It provides Nurses and other health care professionals direct access to robust tools and materials, from 3D printers to Velcro, to create new and better devices that improve the way they care for patients. 

According to the company's website, the MakerHealth Space is stocked with adhesives and fasteners, such as Velcro and zip ties; textiles and electronics, including sensors and microcontrollers; and a range of tools, from pliers and sewing needles to 3D printers and laser cutters. The space is divided into a series of workstations, each equipped to address a specific medical challenge, such as fluid control or assistive technology.

PICU Neonatal Transport Nurse, Brittany Hruska, started researching and creating earmuffs for babies in the neonatal intensive care unit a couple years ago. 

"In the NICU, we have a lot of noise that we can't eliminate between the ventilators and just talking that happens. There's been tons of research on how damaging it is to babies. It's bad for their growth, development. It's bad for their brains," said Hruska.

A MakerHealth pop-up lab was set up at Blank Children’s Hospital and helped her improve her invention. Hruska said, "Before I was hand cutting these. They would take me about an hour to make a set of them. The MakerNurse program had people who helped me learn how to do computer aided design software and we 3D printed molds and they helped me find liquid foam, so now I can make lots of these pretty quickly."

The first MakerHealth Space was at John Sealy Hospital at The University of Texas Medical Branch at Galveston. According to the Robert Wood Johnson Foundation, Jason Sheaffer, Nurse manager in that burn unit, used PVC piping with 3D printed connectors to make a modular irrigation system to attach to the burn unit tub, creating a shower system that will help Nurses more efficiently and effectively treat burn patients. Dolly McCarley, from that Medical Surgical unit, laser cut acrylic attachments for patient IV poles to keep supplies closer at hand. Debra Flynn, from that Labor and Delivery Unit, fabricated protective sleeves for patient IVs using an impulse sealer, vinyl and string. Dell Roach in Cardiothoracic Surgery designed a template for placing 12-lead EKGs on pediatric patients.

To learn more about MakerHealth and their MakerNurse program, click here.

The policy released by AAP defines Racism as a “system of structuring opportunity and assigning value based on the social interpretation of how one looks (which is what we call ‘race’) that unfairly disadvantages some individuals and communities, unfairly advantages other individuals and communities, and saps the strength of the whole society through the waste of human resources.”

Dr. Maria Trent, a professor of pediatrics at Johns Hopkins School of Medicine, who was one of the co-authors of the statement, called racism a "socially transmitted disease. It is taught and it is passed down, but the impacts on children and families are significant from a health perspective."

According to the statement, The impact of racism has been linked to birth disparities and mental health problems in children and adolescents.^6,24–30 The biological mechanism that emerges from chronic stress leads to increased and prolonged levels of exposure to stress hormones and oxidative stress at the cellular level. Prolonged exposure to stress hormones, such as cortisol, leads to inflammatory reactions that predispose individuals to chronic disease.³¹ As an example, racial disparities in the infant mortality rate remain,³² and the complications of low birth weight have been associated with perceived racial discrimination and maternal stress.^25,33,34

The statement directs pediatricians to consider their own practices from this perspective. “It’s not just the academy telling other people what to do, but examining ourselves,” Dr. Trent said.

It is imperative that pediatric clinical settings make everyone feel they are welcome. You can display images of diverse families on your walls and post signs in multiple languages. The toys, books, and videos in the waiting room should be multicultural as well.

Care should be provided in different languages. Does your staff represent the diverse patient populations they are treating? Everyone from the reception desk to the clinical staff seeing patients in the exam rooms should be trained in culturally competent care. Ask yourself, have you created a safe and welcoming space for all patients?

Clinical staff must examine and acknowledge their own biases as well as embrace and advocate for innovative policies throughout their communities.

To read the full statement policy by AAP, click here.

As a Nurse Practitioner, the state you live and work in has different laws and regulations that impact your practice. There are 3 different authorization categories -- Full Practice, Reduced Practice, and Restricted Practice. Here are the details and states for each practice.

The American Association of Nurse Practitioners defines each category below.

Full Practice
State practice and licensure laws permit all NPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing. This is the model recommended by the National Academy of Medicine, formerly called the Institute of Medicine, and the National Council of State Boards of Nursing.

Reduced Practice
State practice and licensure laws reduce the ability of NPs to engage in at least one element of NP practice. State law requires a career-long regulated collaborative agreement with another health provider in order for the NP to provide patient care, or it limits the setting of one or more elements of NP practice.

Restricted Practice
State practice and licensure laws restrict the ability of NPs to engage in at least one element of NP practice. State law requires career-long supervision, delegation or team management by another health provider in order for the NP to provide patient care.

Full Practice States

• Alaska
• Arizona
• Colorado
• Connecticut
• Hawaii
• Idaho
• Iowa
• Maine
• Maryland
• Minnesota
• Montana
• Nebraska
• Nevada
• New Hampshire
• New Mexico
• North Dakota
• Oregon
• Rhode Island
• Vermont
• Washington
• Wyoming

Reduced Practice States

• Alabama
• Arkansas
• Delaware
• Illinois
• Indiana
• Kansas
• Kentucky
• Louisiana
• Massachusetts
• Michigan
• Mississippi
• New Jersey
• New York
• Ohio
• Pennsylvania
• South Dakota
• Utah
• Virginia
• West Virginia
• Wisconsin

Restricted Practice States

• California
• Florida
• Georgia
• Missouri
• North Carolina
• Oklahoma
• South Carolina
• Tennessee
• Texas

The demand for NP’s with Full Practice authority continues to increase rapidly as more Doctors choose to pursue other specialties rather than family medicine or primary care.

Do you have any comments you’d like to share about these regulations?

In 2018, approximately 52 children died after being left in an overheated vehicle. That is the highest number in the past 20 years, according to the National Safety Council.

Emergency Room Nurse Maria Striemer, RN, BA, witnessed a child in her care almost die from heat exhaustion after being accidentally left in a hot car.

The air temperature inside vehicles rises dramatically. According to an article from the Journal of Emergency Medical Services, the air temperature inside a vehicle parked in the sun with variable outside temperatures increased by approximately 20˚ in 10 minutes. By 20 minutes, the inside air temperature was 29˚ higher than ambient temperatures. By 60 minutes, a variety of vehicle types and ambient temperatures will reach similar peak interior temperatures of 140–180˚ F.

Even a brief entrapment in a vehicle can expose a child to heatstroke. The shortest recorded fatal exposure was 15 minutes. The core body temperature of deceased victims was between 102.9–109˚ F.

Maria knew there had to be a simple solution to prevent these tragedies from happening. She and her engineer husband, Grant, used their 3D printer in their basement to create the "Backseet Buddy".

The Backseet Buddy is a silicon device placed on a child’s car seat designed to pair with an app on an iPhone or Android. Using Bluetooth technology, the device and app can detect when a phone has moved more than 50 meters from a car seat with the sensor still activated and sends an alert to the phone.

Maria and Grant received a patent and are meeting with venture capitalists. They hope to bring the product to market in 2020.

“I have many first-time parents telling me they have fears of being sleep deprived or distracted, and how badly they want this product. It would be amazing if it were in the hands of parents before they leave the hospital,” Maria said.

Nursing can be a tough profession. There may be days that stress you out and make you feel bad about yourself. You might question if this is the right job for you or if you're good enough to be a Nurse. Here are a few tips to improving your confidence and staying positive during difficult times.

Fake it till you make it?

An American Sentinel University article discusses the popular mantra and says, "Clearly, as a Nurse you cannot ethically fake skills or knowledge you don’t have. What you can do is to convey confidence that you don’t necessarily feel, by flipping the script. For example, when you don’t know what to do for a patient in distress, don’t focus on your knowledge gap- instead, try to feel confident about your ability to leverage whatever resources you need to figure out the next steps."

Never Stop Learning

No one knows everything but constantly learning and growing your knowledge will make you feel more confident. Always ask questions if you're unsure about something. Try taking workshops or individual classes in areas that you’re not familiar with or want to expand your skillset. Knowledge is power!

Don't Compare Yourself

Sometimes our insecurities can come from watching someone do a great job and wonder if you're doing good enough. Instead of comparing how you work and what you have to others, be proud of the skills you do have and tell yourself you are doing a great job and you are doing the best you can. 

Stand Up to Bullies

Unfortunately, we know bullying exists in the Nursing profession, but you don’t have to succumb to it. Being bullied can effect your self-esteem big time. Bullies feed off of low self-confidence and a passive communication style. Try to hold your head high, make eye contact, and stand up for yourself by speaking with a strong sense of self.

Don't Seek Gratitude

An article by Transition Nursing states, "Unfortunately, as Nurses we are often the last to be “thanked”. You know this to be true and you’ve most likely experienced it. You work hard for your patients, but not every patient will express gratitude. They may be dealing with a new and traumatic diagnosis and because of it, they are not themselves. Remember why you got in to this profession. Be firm in your belief that you have contributed, helped, and cared.

Perfection isn't Real

You are human and no one is perfect. It’s best to admit your flaws and when you've made a mistake. Confident people are able to admit when they are wrong. You cannot convey or build confidence by covering up or denying your role in a mistake, or by reacting defensively. Learn from it and move on.

In your Nursing career, have you experienced self-esteem issues? What helped you overcome those difficult times? Please share with us.

Nursing is an emotionally fulfilling career providing many ups and downs. Hopefully more ups than downs! It isn't an easy path, but if you are called to Nursing, it’s worth it. Some of the best things about being a Nurse are experiences that you won't find in many other jobs. Here are a few reasons why Nurses love being Nurses.

Relationships

Many times you form strong relationships with your patients. You spend all day taking care of their every need. During the course of your shift, you're usually working with the same patients so you form a special bond with them. Being able to get to know someone and help them when they're at their most vulnerable and sick is a really wonderful, gratifying feeling.

Never Boring

In this fast paced environment there's rarely a boring day at work. You’re juggling many important balls and pulled in many directions so there's no time to get bored. There's always something that needs to be done or someone to assist.

Job Security

Job security is another great thing about Nursing. According to the Bureau of Labor Statistics, nearly 3 million Registered Nurses work in the US right now. BSL predicts the country will also add half a million new RN jobs by 2026 due to the aging baby boomer population and an "increased emphasis on preventative care". 

Schedule Flexibility

You can choose a schedule that works for your lifestyle. In the hospital environment, shifts include day, night and weekends. You can also choose what days. There are part-time nursing positions and weekend only programs. Throughout your career, you'll be able to adjust your schedule based on the kind of life your living.

Friendship

The relationships you build with fellow Nurses can last a lifetime. Nursing is usually a very team-oriented profession therefore, you have plenty of people to help you through difficult situations. Over time, your colleagues can become some of your very closest friends. Friendships can form with some patients too.

Career Flexibility

You can change your career path without changing your career. Businesses that employ Nurses include hospitals, private medical practices, schools (School Nurse and Nurse Educators), insurance companies, etc. With additional education and training, you can change your specialty. For example, you could go from being a Clinical Nurse Specialist to a Pediatric Nurse.

Career Satisfaction

Many Nurses tell us they love helping and making a difference in someone's life every single day. They say this is the Nursing profession’s biggest reward.

Do you have a reason why you love being a Nurse that we didn’t include? Please share it with us!